Objective The study aimed to measure the validity of International Classification of Diseases, 10th Edition (ICD-10) code F44.5 for functional seizure disorder (FSD) in the Veterans Affairs Connecticut Healthcare System electronic health record (VA EHR). Methods The study used an informatics search tool, a natural language processing algorithm and a chart review to validate FSD coding. Results The positive predictive value (PPV) for code F44.5 was calculated to be 44%. Discussion ICD-10 introduced a specific code for FSD to improve coding validity. However, results revealed a meager (44%) PPV for code F44.5. Evaluation of the low diagnostic precision of FSD identified inconsistencies in the ICD-10 and VA EHR systems. Conclusion Information system improvements may increase the precision of diagnostic coding by clinicians. Specifically, the EHR problem list should include commonly used diagnostic codes and an appropriately curated ICD-10 term list for ‘seizure disorder,’ and a single ICD code for FSD should be classified under neurology and psychiatry.

Objective: We investigated whether complete blood count (CBC) analyses during intensive care unit stay could predict 12‐month outcomes in patients with cryptogenic febrile infection–related epilepsy syndrome (FIRES), a subset of new‐onset refractory status epilepticus (NORSE). Methods: Outcomes at 12 months were classified as “unfavorable” (Glasgow Outcome Score [GOS] 1–3) or “favorable” (GOS 4–5). Demographic, clinical, and serial CBC data were collected across treatment phases: (1) no immunotherapy (before initiation or no treatment), (2) first‐line immunotherapy, and (3) second‐line immunotherapy. For each treatment phase, predictive models stratified outcomes based on CBC features using decision tree regression, with separate models for adults and children. Model performance was tested using a leave‐one‐patient‐out approach. Results: We studied 63 patients (34 adults, 29 children) from 12 centers. Unfavorable outcomes occurred in 18 adults and 12 children. Children were more likely to receive second‐line immunotherapy. We analyzed 1530 CBCs (adults: 997 CBCs, including 539 for unfavorable outcomes; children: 533 CBCs, including 415 for unfavorable outcomes). Subgroup analyses revealed differences in CBC levels according to the outcomes and the treatment received. Adults with unfavorable outcomes notably had higher neutrophil‐to‐lymphocyte ratios (NLRs) and monocyte‐to‐lymphocyte ratios (MLRs), whereas children with unfavorable outcomes had higher red cell distribution width. NLRs and MLRs increased when CBCs were collected after the initiation of immunotherapy for both adults and children. The variables of interest differed in the different predictive models but always included the proportion of at least one subtype of leukocyte. Prediction accuracy with our models was higher in children (87% overall, with the best performance in no‐treatment and first‐line phases) than in adults (83% overall, with the best performance during/after the initiation of second‐line). Significance: Findings suggest the potential for standard CBCs to serve as a rapid, accessible tool for early prognostication in cryptogenic FIRES, particularly in children.

Status epilepticus (SE) is a life‐threatening neurological emergency with consensus‐driven definitions for onset but no standardized criteria for its end point. This gap creates uncertainty in research and clinical practice. We conducted a scoping review to evaluate how end points have been defined in SE research and to identify key areas of variability. Comprehensive searches of MEDLINE, Embase, and CENTRAL (Cochrane Central Registry of Controlled Trials; 1980–2025) yielded 3940 citations (1674 unique). After screening, 207 studies met the inclusion criteria and were charted using scoping review methodology (Preferred Reporting Items of Systematic Reviews and Meta‐Analyses, extension for scoping reviews). Data were extracted on terminology, electroencephalography (EEG) use, temporal thresholds, and definitions of therapeutic success across retrospective and prospective designs. Five domains of heterogeneity were identified: (1) semantic terminology (e.g., “resolved,” “controlled,” “terminated,” “cessation”); (2) EEG confirmation of the SE end point (reported in 54% of studies, with variable criteria); (3) whether time was included in defining the end point; (4) how quickly seizures were judged to have stopped, based on clinical signs, EEG findings, or both; and (5) how long seizure freedom had to be maintained to count as a successful end point. No consistent global or time‐based patterns were identified, and overlapping terminology further limited comparison across studies. Despite established consensus definitions for SE onset, the end point remains variably defined, undermining methodological rigor and limiting cross‐study synthesis. A unified, consensus‐driven framework is urgently needed to standardize SE end points through the use of standard terminology and methodologies, thereby strengthening clinical trial design and facilitating regulatory evaluation of novel therapies.

Objective: Cryptogenic new onset refractory status epilepticus (cNORSE) carries high risks of long‐term disability and post‐NORSE epilepsy, but mechanisms remain unclear. We aimed to assess the predictive value of inflammatory and brain injury biomarkers and determine whether immune disturbances persist in the chronic phase. Methods: We enrolled 93 cNORSE patients from the Pitié‐Salpêtrière Hospital and the Yale NORSE/FIRES biorepository (2013–2025). Serum and cerebrospinal fluid (CSF) samples were collected during status epilepticus (SE), with outcomes assessed 6–12 months after resolution. To investigate post‐cNORSE epilepsy, we compared 39 post‐cNORSE patients (25 with paired acute samples) to 40 patients with temporal lobe epilepsy due to hippocampal sclerosis (TLE‐HS) and 20 with chronic immune‐mediated encephalitis. Results: During cNORSE, elevated innate cytokines (serum CXCL8, CCL2; CSF IL‐6, CXCL8, CCL2, MIP‐1α, G‐CSF) and brain injury biomarkers (serum and CSF neurofilament light chain [NfL], CSF neuron‐specific enolase) correlated with worse functional outcomes. Multivariate models demonstrated that adding serum NfL to cytokines improved poor outcome prediction (area under the curve = .75). In contrast, no acute biomarker predicted post‐cNORSE epilepsy, which was instead associated with prolonged SE, magnetic resonance imaging abnormalities, and the need for more intensive treatment. In paired analyses, most serum cytokines normalized during the chronic phase, particularly IL‐6, IL‐10, and IL‐1β, although new adaptive immune disturbances (IL‐17A, IL‐12p70, TNFα) appeared in 20% of patients. No chronic elevations of innate cytokines were observed in post‐cNORSE patients. Conversely, elevated age‐adjusted NfL levels were more frequent in post‐cNORSE epilepsy (64%) than encephalitis (45%) and TLE‐HS (20%), ( p < .001), with elevated NfL levels correlating with poor functional outcomes ( p = .019). Significance: Innate immune activation is a hallmark of acute cNORSE but largely resolves in the chronic phase, arguing against persistent innate inflammation as the driver of post‐cNORSE epilepsy. In contrast, persistently elevated NfL levels suggest ongoing axonal injury, potentially contributing to poor outcomes. Integrating inflammatory and neuroaxonal injury biomarkers may improve risk stratification and guide long‐term management.